Sugar – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAThu, 17 Aug 2017 07:31:26 +0000en-UShourly1https://wordpress.org/?v=4.2.290498487Americans Are Consuming Less Sugar With Decline in Soda Intakehttps://ww2.kqed.org/stateofhealth/2016/09/20/americans-are-consuming-less-sugar-with-decline-in-soda-intake/
https://ww2.kqed.org/stateofhealth/2016/09/20/americans-are-consuming-less-sugar-with-decline-in-soda-intake/#respondTue, 20 Sep 2016 16:35:37 +0000http://ww2.kqed.org/stateofhealth/?p=239326Sugar has become the nutritional villain du jour, but just how bad is our addiction? The answer is tricky.

Philadelphia recently passed a tax on sugary drinks, several other places have proposed them, and the government this year recommended we limit our intake of added sugars to 10 percent of daily calories, underscoring how significant elected officials believe the problem is. But while determining exactly how much sugar we’re consuming is a complicated business — government figures are estimates— the data and industry trends indicate we’ve actually made progress in cutting back.

On average, Americans’ total consumption of caloric sweeteners like refined cane sugar and high-fructose corn syrup is down 15 percent from its peak in 1999, according to government data. That’s when we consumed an average of 111 grams of sugar a day (423 calories).

After plateauing in recent years, consumption was down to 94 grams a day (358 calories) last year, according to the U.S. Department of Agriculture, which calculates the figures by estimating how much of the caloric sweeteners produced are never eaten. But that level is still higher than the 87 grams Americans consumed on average in 1970.

A major factor for the drop appears to be the decline in soda consumption, as the high-fructose corn syrup used to sweeten drinks like Sprite and Mountain Dew has been on the decline.

Thomas Farley, the health commissioner in Philadelphia, said it could take many years before the positive effects from the reductions in soda consumption to turn up in health data. But he also noted that factors like the growth in snacking, the availability of food in more places, and oversized restaurant dishes can fuel obesity.

“Sugar is a problem, but sugar is not the only problem,” Farley said.

And though it’s lower, sweetener consumption of 94 grams a day is still the equivalent of roughly two and half cans of Coke. That far exceeds the government’s recommendation to limit added sugar to around 50 grams a day (200 calories) for someone on a 2,000-calorie diet.

Notably, a per capita consumption figure doesn’t account for the wide disparities in intake among individuals. The way the USDA estimates sweetener consumption also means the specific figure could be higher or lower. The agency changed its methodology in 2012, which meant a sharp reduction in how much sugar it said we consume. Emails obtained by the Center for Science in the Public Interest, which supports soda taxes, show that a sugar industry group wanted the change and hoped for “as low a per capita sweetener consumption estimate as possible.”

There’s always room for “improvement and refinement” in making food consumption estimates, said Michael McConnell, an agriculture economist who specializes in sweeteners at the USDA. But he said the change in methodology was applied retroactively, so any trend the numbers show would still be consistent. Even if the numbers are inexact, others agree the downward trajectory in sweeteners makes sense.

That’s because soda consumption started falling around the same time, and is down 24 percent since 1998, according to industry tracker Beverage Digest. Michael Jacobson, executive director of the CSPI, thinks it’s a major factor — and perhaps the entire reason — for the drop in sweetener consumption.

The American Beverage Association, the trade group for Coke and Pepsi, says soda isn’t the driver of obesity rates, since those levels have climbed as soda drinking has declined.

Gary Taubes, a science author, believes the influx of sweeteners and refined carbohydrates in diets has likely fueled obesity, but notes there’s ambiguity in the evidence.

And Cristin Kearns, a former dentist who has been uncovering documents showing the sugar industry’s influence on nutrition science, noted that “manufacturers are getting crafty” about the types of sweeteners they use, such as juice concentrate, meaning they might not show up in consumption figures.

As sugar comes under fire, food companies are using sophisticated new methods to reduce sweeteners without sacrificing sweetness. Consider the use of “sweet taste boosters” that amplify smaller amounts of sweeteners. The ingredients are listed as “artificial flavors” on packages, according to Senomyx, a California company that makes them.

Earlier this year, MycoTechnology began making a “bitter blocker” that reduces the need for sweeteners that mask bitterness. The Colorado company says it is made from a mushroom extract and can be listed as a “natural flavor.”

Some companies have also switched back to “real sugar” to give their products a more wholesome image, even though there may be no difference in calories. While the overall decline in sweeteners reflects the drop in high-fructose corn syrup, the consumption of refined sugar has actually edged up in recent years.

In that small regard, sugar is enjoying a revival.

]]>https://ww2.kqed.org/stateofhealth/2016/09/20/americans-are-consuming-less-sugar-with-decline-in-soda-intake/feed/0239326Sugar Industry Funded 1960s Harvard Research That Blamed Heart Disease on Fathttps://ww2.kqed.org/stateofhealth/2016/09/12/sugar-industry-funded-1960s-harvard-research-that-blamed-heart-disease-on-fat/
https://ww2.kqed.org/stateofhealth/2016/09/12/sugar-industry-funded-1960s-harvard-research-that-blamed-heart-disease-on-fat/#commentsMon, 12 Sep 2016 18:37:27 +0000http://ww2.kqed.org/stateofhealth/?p=236447The sugar industry began funding research that cast doubt on sugar’s role in heart disease — in part by pointing the finger at fat — as early as the 1960s, according to an analysis of newly uncovered documents.

The analysis published Monday is based on correspondence between a sugar trade group and researchers at Harvard University, and is the latest example showing how food and beverage makers attempt to shape public understanding of nutrition.

In 1964, the group now known as the Sugar Association internally discussed a campaign to address “negative attitudes toward sugar” after studies began emerging linking sugar with heart disease, according to documents dug up from public archives. The following year the group approved “Project 226,” which entailed paying Harvard researchers today’s equivalent of $48,900 for an article reviewing the scientific literature, supplying materials they wanted reviewed, and receiving drafts of the article.

The resulting article published in 1967 concluded there was “no doubt” that reducing cholesterol and saturated fat was the only dietary intervention needed to prevent heart disease. The researchers overstated the consistency of the literature on fat and cholesterol, while downplaying studies on sugar, according to the analysis.

“Let me assure you this is quite what we had in mind and we look forward to its appearance in print,” wrote an employee of the sugar industry group to one of the authors.

The sugar industry’s funding and role were not disclosed when the article was published by the New England Journal of Medicine. The journal, which did not require such disclosures at the time, began requesting author disclosures in 1984.

In an editorial published Monday that accompanied the sugar industry analysis, New York University professor of nutrition Marion Nestle noted that for decades following the study, scientists and health officials focused on reducing saturated fat, not sugar, to prevent heart disease.

While scientists are still working to understand links between diet and heart disease, concern has shifted in recent years to sugar and carbohydrates, and away from fat, Nestle said.

A committee advising the federal government on dietary guidelines says the available evidence shows “no appreciable relationship” between the dietary cholesterol and heart disease, although it still recommended limiting saturated fats.

The American Heart Association cites a study published in 2014 in saying that too much added sugar can increase risk of heart disease, though the authors of that study says the biological reasons for the link are not completely understood.

The findings published Monday are part of an ongoing project by a former dentist, Cristin Kearns, to reveal the sugar industry’s decades-long efforts to counter science linking sugar with negative health effects, including diabetes. The latest work, published in the journal JAMA Internal Medicine, is based primarily on 31 pages of correspondence between the sugar group and one of the Harvard researchers who authored the review.

In a statement, the Sugar Association said it “should have exercised greater transparency in all of its research activities,” but that funding disclosures were not the norm when the review was published. The group also questioned Kearns’ “continued attempts to reframe historical occurrences” to play into the current public sentiment against sugar.

The Sugar Association said it was a “disservice” that industry-funded research in general is considered “tainted.”

Companies including Coca-Cola Co. and Kellogg Co. as well as groups for agricultural products like beef and blueberries regularly fund studies that become a part of scientific literature, are cited by other researchers, and are touted in press releases.

Companies say they adhere to scientific standards, and many researchers feel that industry funding is critical to advancing science given the growing competition for government funds. But critics say such studies are often thinly veiled marketing that undermine efforts to improve public health.

“Food company sponsorship, whether or not intentionally manipulative, undermines public trust in nutrition science, contributes to public confusion about what to eat,” wrote Nestle, a longtime critic of industry funding of science.

The authors of the analysis note they were unable to interview key actors quoted in the documents because they are no longer alive. They also note there is no direct evidence the sugar industry wrote or changed the manuscript, that the documents provide a limited window into the activities of the sugar industry group and that the roles of other industries and nutrition leaders in shaping the discussion about heart disease were not studied.

Nevertheless, they say the documents underscore why policy makers should consider giving less weight to industry-funded studies. Although funding disclosures are now common practice in the scientific community, the role sponsors play behind the scenes is still not always clear.

In June, the Associated Press reported on a study funded by the candy industry’s trade group that found children who eat candy tend to weigh less than those who don’t. The National Confectioners Association, which touted the findings in a press release, provided feedback to the authors on a draft even though a disclosure said it had no role in the paper. The association said its suggestions didn’t alter the findings.

In November, the AP also reported on emails showing Coca-Cola was instrumental in creating a nonprofit that said its mission was to fight obesity, even though the group publicly said the soda maker had “no input” into its activities. A document circulated at Coke said the group would counter the “shrill rhetoric” of “public health extremists.”

Coca-Cola subsequently conceded that it had not been transparent, and the group later disbanded.

And today comes the official advice from the U.S. government: The Obama administration has released its much-anticipated update to the Dietary Guidelines.

The guidelines, which are revised every five years, are based on evolving nutrition science and serve as the government’s official advice on what to eat.

One concrete change: Americans are being told to limit sugar to no more than 10 percent of daily calories.

As we’ve reported, lots of Americans consume up to 22 teaspoons a day. To meet the new 10 percent target, they’d need to cut their sugar intake by nearly half — to no more than 12 teaspoons a day on a 2,000-calorie daily diet.

These two muffins each contain 35 grams (about 8 teaspoons) of sugar. Add in a cup of sweetened blueberry Greek yogurt (18 grams, or about 4 teaspoons, of sugar) and you’ve got 22 teaspoons of sugar – the amount many Americans eat per day. Under the new Dietary Guidelines, we should eat no more than 10 percent of daily calories from sugar. On a 2,000-calorie daily diet, that’s about 12 teaspoons. (Morgan McCloy/NPR)

Over the past five years, a growing body of evidence has linked high levels of sugar consumption to an increased risk of Type 2 diabetes and heart disease, even among Americans who are not overweight or obese.

Much of the dietary advice included in the new guidelines will sound very familiar and remains unchanged from 2010. For instance, there’s a focus on consuming more fruits and vegetables, more fiber and whole grains, and less salt.

Top administration officials within the U.S. departments of Agriculture and Health and Human Services, who were tasked with writing the guidelines, decided not to include some of the recommendations made by a Dietary Guidelines advisory panel that reviewed the latest nutrition science.

For instance, the advisory committee had recommended including sustainability as a factor in making food choices. But administration officials nixed that idea.

The committee had also advised telling Americans to cut back on red and processed meats. But that recommendation sparked a vigorous challenge from the meat industry, and the final dietary guidelines do not include any specific advice to cut back on these sources of protein.

The recommendation “was certainly controversial,” says Tom Brenna, a nutrition professor at Cornell University and member of the Dietary Guidelines Advisory Committee.

“The red and processed meat recommendation, I think, has morphed a bit into a different kind of message,” Brenna tells us. “A little bit like turning a coin over, in a sense, where if you eat less red meat, one is eating more of other protein foods.”

Instead, the guidelines emphasize a “shift towards other protein foods” — including more nuts and seeds and about 8 ounces of seafood per week, based on a 2,000-calorie-a-day diet.

The suggestion to limit meat intake comes in more subtle form. For instance, the guidelines point out that many teen boys and adult men consume more than the recommended 26 ounces a week of protein from animal sources, so they should “reduce overall intake of protein foods by decreasing intakes of meat, poultry, and eggs.”

There’s also an overall recommendation — unchanged from 2010 — to reduce saturated fat intake to less than 10 percent of daily diet, a shift that could, in practice, require limiting intake of red meat.

“The message to eat more seafood, legumes and other protein foods really does mean substitute those for red meat,” Brenna says. “So I think the message is more or less there, it’s just not as clear.”

That message to cut the red meat should have been stated more directly, says Barry Popkin, a nutrition researcher at the University of North Carolina, Chapel Hill. “I am disappointed that the USDA once again is cutting out recommendations to truly limit red meat intake,” he tells us in an email.

The other major change to the government’s nutrition advice: dietary cholesterol. The new guidelines drop a long-standing recommendation to limit cholesterol from foods to 300 milligrams a day.

As Alice Lichtenstein, vice chairwoman of the the expert panel that advised the government on the guidelines, told us last February, there isn’t strong evidence that limiting cholesterol-rich foods lowers the amount of artery-clogging LDL cholesterol that ends up in the blood.

The guidelines also call on Americans to cut sodium to no more than 2,300 milligrams per day. Most of us consume far more — about 3,440 milligrams daily on average — much of it in the form of foods like pizzas, soups, breads and cured meats.

The Dietary Guidelines have clear implications for federal nutrition policy, influencing everything from the national school lunch program to the advice you get at the doctor’s office. But they are written for nutrition professionals, not the general public.

Indeed, one has to wonder whether most Americans are even listening. As the Dietary Guidelines report points out, three-fourths of Americans don’t eat the recommended amount of fruits and vegetables. In some age groups (think teens), the percentage of people following the guidelines is in the single digits.

The sugar industry worked to steer federal health research, a report released Monday revealed.

As State of Health reported, newly uncovered industry documents dating to the1960s showed that the sugar industry influenced the National Institute of Dental Research, part of the National Institutes of Health, away from looking at research to determine strategies to encourage people to eat less sugar.

“What this shows is that sugar interests were running science manipulation in as sophisticated a manner as ‘big tobacco’ was back in the ’50s and ’60s,” said UCSF Professor Stan Glantz, a co-author of the study and longtime anti-tobacco advocate.

Earlier today, Glantz sent me a short but pointed follow that he posted on the UCSF Center for Tobacco Control, Research and Education website.

It is challenging for the current Sugar Association staff to comment directly on documents and events that allegedly occurred before and during Richard Nixon’s presidency, given the staff has changed entirely since the 1970s. However, we are confused as to the relevance of attempts to dredge up history when decades of modern science has provided answers regarding the role of diet in the pathogenesis of dental caries… A combined approach of reducing the amount of time sugars and starches are in the mouth, drinking fluoridated water, and brushing and flossing teeth, is the most effective way to reduce dental caries. [Time shortened the statement for brevity]

In his post, Glantz then noted: “This sounds simliar to the statement from Brown and Williamson Tobacco put out in 1995 in response to our first papers based on tobacco industry documents:”

Lifting single phrases or sentences from 30 year-old documents and using that information to distort and misrepresent B&W’s position on a number of issues is clearly what is occurring … We continue to believe that nicotine is not addictive because over 40 million Americans have quit smoking, 90 percent of them without any help at all.

Hundreds of pages of newly-found documents show that the sugar industry worked closely with the federal government in the late 1960s and early 1970s to determine a research agenda to prevent cavities in children, researchers who analyzed the documents say.

“The sugar industry … is following the tobacco industry’s playbook.”

In the analysis, published Wednesday in the journal PLOS Medicine, researchers concluded that industry influence starting in the late 1960s helped steer the National Institute of Dental Research, part of the National Institutes of Health, away from addressing the question of determining a safe level of sugar.

“What this paper has shown is that our (NIH) was working toward potentially answering that question,” said Cristin Kearns, a fellow at UC San Francisco and lead author of the analysis, “and the sugar industry derailed them from doing the research to help to answer that question, so we’re still debating (it) here in 2015.”

Kearns uncovered the 1,551 pages of documents at a public archive at the University of Illinois.

The documents show that an expert panel formed by the sugar industry included all but one member of the government panel that was examining priorities for research.

Ultimately, a report from the industry was submitted to the government panel and became the foundation for research going forward. “Seventy-eight percent of the sugar industry submission was incorporated into the NIDR’s call for research applications. Research that could have been harmful to sugar industry interests was omitted,” the authors note.

“What this shows is that sugar interests were running science manipulation in as sophisticated a manner as ‘big tobacco’ was back in the 50s and 60s,” said UCSF Professor Stan Glantz, a co-author of the study and long time anti-tobacco advocate.

Marion Nestle, professor nutrition of New York University was not involved in the analysis, which she called “incredibly revealing.”

The paper “makes it clear that the sugar industry systematically and deliberately adopted strategies to make sure that federal research agencies did not urge the public to cut down on sugar intake as a means to prevent tooth decay,” she said.

“I can attest that the sugar industry is especially aggressive in defending itself against any suggestion to eat less and is following the tobacco industry’s playbook.”

In a statement, the Sugar Association said it “questions the relevance of attempts to dredge up history when decades of modern science has provided answers regarding the role of diet in the pathogenesis of dental caries.”

The statement also says that the authors’ “use of attention-grabbing headlines and scare tactics that liken consumption of all-natural sugar … to a known carcinogen is a ‘textbook’ play from the activist agenda.”

The authors admit their analysis is limited because it “provides a narrow window into the activities of just one sugar industry trade association” and that they could not “interview key actors.”

A Long Hunt

Cristin Kearns found the papers after a long hunt. In 2007, she says, while attending a conference, she was handed a government pamphlet titled, “How to Talk to Patients About Diabetes.” She was startled that the diet advice didn’t mention reducing sugar intake. It made her wonder if the sugar industry “somehow impacted what the government can or cannot say about diet advice for diabetics?”

She started searching online and, ultimately quit her day job. After months of looking, she uncovered some documents and ultimately identified the documents discussed in the analysis today.

Kearns says there are more documents to be found, “just need time and money to do it.” And, with an eye toward the history of tobacco litigation, she believes litigation is “certainly a possibility” in this case as well. “We’ve only just begun to scratch the surface of understanding some of the tactics the sugar groups have implemented.”

These days, sugar is pretty close to everywhere in the American diet. You probably know that too much sugar is probably not great for your health.

Now, a new initiative from UC San Francisco is spelling out the health dangers in clear terms. The project is called “sugar science,” and science there is.

A team of researchers distilled 8,000 studies and research papers, and found strong evidence showing overconsumption of added sugar overloads vital organs and contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease.

While there are no federal guidelines recommending a limit on sugar consumption, the American Heart Association (AHA) recommends cutting our consumption way down. Right now, the average American consumes the equivalent of 19.5 teaspoons a day in added sugars. The AHA says men should cut that down to no more than 9 teaspoons and women should consume less than 6 teaspoons.

UCSF Professor Laura Schmidt is lead investigator on the project. “Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American … consume too much added sugar.”

As part of its outreach, Schmidt’s team has created a user-friendly website and is partnering with health departments across the country to spread the word. The website includes downloadable resources, including television commercials, that public health officials can localize for their own cities.

“And that’s what sugar science is all about,” Schmidt says. “It’s about translating the information that’s locked up in the medical journals and sharing it with the public in ways that are understandable.”

Health departments from San Francisco to New York City have already agreed to participate in outreach. In a statement, the New York Department of Health called Sugar Science a “wonderful resource” and said it was “something that can be used by researchers, the public health community and those who just want thorough information.”

Schmidt is quick to point to the food environment as a driver in the increase of obesity that America has seen in the last generation. “It’s not like Americans suddenly lost their willpower,” she says. “The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s.”

That sugar isn’t just making us fat, she says, “it’s making us sick.”

Schmidt insists the team, which includes researchers from UC Davis and Emory University, is not “anti-sugar.” Instead, it’s really about knowing how much sugar is too much.

But knowing how much sugar you’re eating can be challenging. Some key facts on the Sugar Science website are these:

Added sugar is hiding in 74 percent of packaged foods. (Proposed changes to the nutrition label would change this by including a separate line for added sugars.)

A common type of sugar can damage your liver — just like too much alcohol.

One 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third.

The site also includes tips on concrete steps that people can take to cut down on sugar. The most straightforward way to cut down on sugar is to stop drinking sugar-sweetened drinks, like sodas, sports drinks and energy drinks, the researchers say. More than one-third of added sugar in the diet comes from sugary drinks. They also recommend reading nutrition labels. While there are 61 different names for sugar on ingredients labels, the UCSF team says that “if the chemical name has an ‘ose’ at the end—as in dextrose, fructose, lactose —- it’s likely to be added sugar.”

Seeing Diabetes as the AIDS Crisis of This Generation

Dean Schillinger is also part of the Sugar Science team. He’s a primary care doctor at San Francisco General Hospital. He first came to San Francisco in 1990 at the peak of the AIDS epidemic. “At that point, one out of every two patients we admitted was a young man dying of AIDS,” he says. At that time, there were no treatments, little any doctor could do.

Today, he says, there are good treatments, and it’s rare to admit someone to the hospital dying of AIDS.

Instead, Schillinger says, that same ward, Ward 5A, where young men died of AIDS is now filled with diabetes patients.

“I feel like we are with diabetes where we were in 1990 with the AIDS epidemic,” Schillinger said. “The ward is overwhelmed with diabetes –- they’re getting their limbs amputated, they’re on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life.”

But unlike AIDS, where activists pushed hard for action from researchers and governments, there’s little activist response for diabetes “because it affects low-income communities disproportionately,” Schillinger said. “We’re at the point where we need a public health response to it.”

The timing of the SugarScience launch is not a coincidence. The UC researchers waited until after the election last week voters in Berkeley and San Francisco were considering soda tax measures. Measure D in Berkeley passed with 75 percent of the vote. Schmidt says that since the university is a public institution, it could not be seen as trying to sway votes with the announcement of the new initiative.

Now comes a new study, published in JAMA Internal Medicine, which finds that Americans who consumed the most sugar — about a quarter of their daily calories — were twice as likely to die from heart disease as those who limited their sugar intake to 7 percent of their total calories.

To translate that into a 2,000-calorie a day diet, the big sugar eaters were consuming 500 calories a day from sugar — that’s 31 teaspoons. Those who tamed their sweet tooth, by contrast, were taking in about 160 calories a day from sugar — or about 10 teaspoons per day.

Unfortunately, most Americans have a sugar habit that is pushing toward the danger zone.

“The average American is consuming 22 teaspoons a day. That’s about three times what’s recommended,” says Laura Schmidt of the U.C. San Francisco School of Medicine.

Now, we should point out, we’re not talking fruit here. Researchers did not include the sugar naturally occurring in fruit or milk. Instead, the study focused specifically on the risks of added sugar — the refined sugars and corn syrups added to foods such as baked goods and sugary sodas.

So, how much added sugar is OK?

For starters, the American Heart Association advises that women consume no more than 6 teaspoons of sugar daily. This is about 100 calories. And men, no more than 9 teaspoons, or about 150 calories from sugar.

The World Health Organization says people should get no more than 10 percent of their daily calories from sugar.

And the last time the federal government weighed in on sugar was in the 2010 Dietary Guidelines, which make only a broad recommendation to reduce consumption of added sugar.

So how best to reduce sugar?

Some steps are fairly obvious. For example, eliminating one 12-ounce can of sugar-sweetened soda can cut about 9 teaspoons of sugar.

But other common sources of added sugar can take you by surprise. For example, this morning I ate a small, 4-ounce cup of low-fat organic peach yogurt. I chalked it up as a very healthy breakfast, but when I looked at the nutrition label, it had 17 grams of sugar.

“You just shot most of your wad” for the day, Schmidt points out.

So, yeah, swap those sweetened yogurts for plain yogurt. A typical 6-ounce serving of vanilla yogurt has about 6 teaspoons of sugar — which is about as much as a regular size Snickers bar.

Bottom line: Read the labels. Most nutrition labels list sugar in grams. Four grams of sugar is equivalent to about one teaspoon.

And, don’t get forgot to count sugar if you’re eating out. There can be lots of sugar added to breakfast foods.

For instance, stopping at Starbucks to pick up a blueberry muffin with your latte? That muffin, according to the Starbucks website, contains 29 grams of sugar, or roughly 7 teaspoons.

And an Apple Crumb Donut at Dunkin Donuts will set you back 49 grams of sugar — that’s more than a day’s worth of added sugar.

There’s a lot of variability in baked goods. For instance, another option at Dunkin Donuts, the Cocoa Glazed Donut, has much less sugar, 13 grams.

]]>https://ww2.kqed.org/stateofhealth/2014/02/04/sugar-is-a-risk-for-heart-disease-too/feed/117466Study: Sugar — Independent of Obesity — Causes Diabeteshttps://ww2.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/
https://ww2.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/#commentsThu, 28 Feb 2013 19:49:37 +0000http://blogs.kqed.org/stateofhealth/?p=10834For years, doctors have debated sugar’s role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it’s the resulting weight gain that leads to diabetes. But a major new study shows a direct link between sugar and diabetes — a link that’s independent of a person’s weight.

KQED’s Stephanie Martin interviewed one of the study’s authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video “Sugar: The Bitter Truth” has more than three million views on YouTube.

“This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s.”

Lustig told Martin that the study was very carefully done — researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.

In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. “Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.”

Lustig said their findings point to proof of causation that should be accepted by doctors. “This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960’s,” he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.

Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.

“Twenty percent of obese people have completely normal metabolic signatures,” Lustig told Martin. “Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than a cause.” He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.

The study was not designed to address whether the type of sugar mattered — for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.

Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to “advise people to keep their sugar a lot lower than it normally is.”

In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. “The question is,” he asked rhetorically, “what does that do to you? What does that do to your liver? What does that do to your pancreas?”

Dr. Robert Lustig is perhaps the most outspoken anti-sugar critic out there. His 90 minute video, Sugar: The Bitter Truth, has netted 3.2 million views on YouTube; his latest book Fat Chance, which, among other things, links sugar to obesity and chronic disease, is currently #68 on Amazon’s Top 100 bestselling books.

On Monday, Lustig was a guest on KQED’s Forum and even though he was fighting a bad cold, he was his usual passionate self on many things related to the American diet, especially sugar. Lustig believes sugar is such a dietary menace that it should be regulated, much the same way alcohol is regulated.

He rattled off a lot of numbers during his discussion with Forum host Michael Krasny.

Nearly one-half cup of sugar per day

“Our current sugar consumption is 22 teaspoons per day, on average … for all of America,” Lustig told Forum‘s audience. For reference, that’s nearly one-half cup. “The American Heart Association put out a scientific statement in 2009 recommending that we reduce that to six teaspoons a day for women and nine teaspoons a day for men.”

To follow Lustig’s recommendations, that means we would need to cut our sugar intake by two-thirds to three-fourths. How did we get here? Our sugar consumption has been climbing for two decades as cited by this 2010 analysis by the UC Berkeley Center on Weight and Health:

“All lines of evidence consistently support the conclusion that the consumption of sweetened beverages has contributed to the obesity epidemic. It is estimated that sweetened beverages account for at least one-fifth of the weight gained between 1977 and 2007 in the US population. Actions that are successful in reducing sweetened beverage consumption are likely to have a measurable impact on obesity.

Sugar-sweetened beverages are a major contributor to overall sugar consumption, but they are not the only one, Lustig says, pointing out that one-sixth of our sugar consumption comes from sweet things like desserts and ice cream. “But … one-half of our sugar consumption is coming in foods that we didn’t even know had it — like tomato sauce, like salad dressing, like barbeque sauce.” And the list goes on.

Lustig had plenty more to say — and addressed criticisms of his science. Listen for yourself here:

Today FDA Commissioner Margaret Hamburg was a guest on KQED’s Forum. Host Michael Krasny asked her if sugar should be removed from the FDA’s “GRAS” category–that’s for Generally Recognized as Safe. Not surprisingly, the Commissioner did not announce imminent action. She said she did have a chance to “look quickly at the initial report” and that “we’ll look very seriously at any new data that’s presented.”

In other words, nothing will be happening soon, just as researcher Robert Lustig expected when I talked to him last week. The commentary was an “opening salvo,” he said. “Nothing in public health changes overnight. It’s not possible to.”

Here’s the Commissioner’s complete response to Krasny’s question:

Sugar is one important area of nutrition where there’s enormous interest in deepening our understanding of the health risks and benefits. It’s an area where consumers want to know more about what’s in the food that they’re eating and where the FDA has a critical role to play in terms of both supporting and building on important new research insights and through our responsibilities for providing accurate information about the content of processed foods.

As the Commissioner continued speaking, she seemed in this next section to be choosing her words very carefully:

So, it’s an important area that sugar, along with other critical nutritional issues, such as sodium and saturated fats and overall calories all require strengthening our understanding of the science and really understanding individual and public health issues and linking that to what we do at the FDA.

Then she picked up steam again here:

But I have had a chance to look quickly at this initial report, I understand the request that’s being made. We’ll look very seriously at any new data that’s presented. In the meantime, consumers should be aware that nutritional information is provided on the back of processed food packages that enables them to look at the relative contribution of different types of sugars in the foods that they’re eating along with other nutritional components and it’s an opportunity to make more informed choices about the food they eat and the food they serve their families.

A spoonful of sugar may have helped the medicine go down when Julie Andrews sang the song, but fast forward to the 21st century and sugar isn’t looking so sweet. Today in a provocative commentary in the journal Nature, researchers argue that sugar is so toxic to our bodies, it should be regulated in the same way alcohol and tobacco are.

The three writers, all from UC San Francisco, say that every country that has adopted the Western diet, with its hallmark of highly-processed food, has seen rising rates of obesity and the diseases that go with it, such as heart disease and diabetes. But, in a turn, they argue against blaming obesity itself. “Obesity is not the cause,” they write, “rather, it is a marker for metabolic dysfunction, which is even more prevalent.” Metabolic syndrome leads to diabetes, high blood pressure, heart disease, fatty liver disease and even cancer, they say.

And the culprit, they insist, is sugar, particularly its fructose component. “Fructose, which is the sweet part of sugar,” said co-author Robert Lustig in an interview, “is toxic beyond its caloric equivalent.” People often refer to sugar as “empty calories,” but they are far from that, the writers say. “A growing body of scientific evidence shows that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills slowly.”

At this point I was getting a sinking feeling. Maybe it’s the way smokers felt when the bad news started coming out about tobacco in the late 50s and early 60s.

Sugar consumption has tripled worldwide in the last 50 years, the writers assert, and they say to combat the myriad health problems we face today, regulation is necessary. Sugar meets four criteria that merit government action. “The first in unavoidability,” Lustig said, “it’s everywhere. The second is toxicity beyond its calories. The third is potential for abuse because it activates the same areas of the brain as alcohol and tobacco creating a cycle of consumption and disease, and the fourth is negative impact on society.” The negative impact on society is largely seen through high health care costs because of the many diseases associated with high sugar consumption.

The authors suggest a combination of taxes on processed foods that contain sugar, and limiting access to children through tighter controls on vending machines in schools, for example. They also recommend promoting healthier foods in government programs for the poor, including the Women, Infants and Children program and Supplemental Nutrition Assistance Program (formerly called Food Stamps).

Not surprisingly, the Sugar Association doesn’t buy much of this. In a statement on their website, the Association says:

… the assertion that a food is less healthy just because it contains sugar is misleading and not science based. Numerous studies have confirmed that sugar makes many healthful foods palatable, which helps contribute to intakes of key vitamins and minerals necessary to maintain good health.

But Lustig views today’s commentary as the “opening salvo” in a long public health discussion. “I don’t expect anything to change anytime soon,” he said. “Nothing in public health changes overnight. It’s not possible to.”

And judging from some of the comments on a CNN story about the issue today, Lustig is right. Here are just two examples:

“unbelievable nannyism. But I forgot that this is America, the land of the hopelessly dependent and depressingly irresponsible,”

“This article should be regulated as total garbage.”

But as the writers close their commentary in Nature, they point to other public health issues: the bans on smoking in public places; the promotion of the designated driver; and airbags in cars. “These simple measures–which have all been on the battleground of American politics–are now taken for granted as essential tools for our public health and wellbeing,” Lustig said. “It’s time to turn our attention to sugar.”